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1.6 Flashcards

1
Q

What is the enteric nervous system?

A

Autonomics + local plexi + interneurones

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2
Q

What is the local plexi of the enteric nervous system of teh GIT divided into?

A

Meissner’s (submucosal) plexus –> mucosal secretions (parasympathetics increases mucosal secretions)

Auerbach’s (myenteric) plexus–> motility

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3
Q

Where in the GIT microanatomy does the enteric system local plexi sit?

A

Meissner’s - sit in submucosa

Auerback’s - sits in muscularis propria between circular and longitudinal muscle

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4
Q

From the lumen (deep) to superfical of the GIT name the layers + what they are divided into.

A

Mucosa

  • Epithelium
  • Lamina propria
  • Muscularis mucosa

Submucosa
- contains Meissner’s plexus

Muscularis propria

  • Circular muscle
  • Auerback’s plexus
  • Longitudinal muscle

Serosa or adventitia

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5
Q

Smooth muscle in the GIT can be tonic-ally or phasic-ally contracted. Does parasym cause relaxation of contraction of these?

A

Tonic contraction relaxed by parasym (e.g. pyloric sphincter)

Phasic contraction contracts by parasym

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6
Q

What is tonically contracted smooth muscle?

A

Muscle that is normally contracted (or most of the time)

Whereas phasic contraction smooth muscle is normally relaxed but will contract when gets a signal

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7
Q

Function of peristalsis?

A

Movement of small boluses along GIT

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8
Q

Function of segmentation?

A

Mixing food up without particularly moving food along any direction

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9
Q

What is migrating motor complex?

A

Clearing undigested food when fasting

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10
Q

What is mass peristalsis?

A

Colonic bulk movement

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11
Q

Are salivary glands exocrine or endocrine glands?

A

Exocrine

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12
Q

Type of secretions from parotid gland?

A

Mostly watery

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13
Q

Type of secretions from submandibular gland?

A

Mixed mucous + watery

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14
Q

Type of secretions from sublingual gland?

A

Mostly mucoid

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15
Q

What do acinar cells of salivary glands secrete?

A 
Amylase
Lipase
IgA
Lactoferrin
Lysozyme
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16
Q

What do goblet cells of the salivary gland secrete?

A

Mucus

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17
Q

The enteric nervous system is under the influence of which nervous system?

A

Autonomic

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18
Q

Exocrine glands secrete primarily secretions from acinar cells, what do ductular cells do?

A

Secondary modification

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19
Q

Does parasympathetic stimulation increase or decrease saliva production?

A

Increases

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20
Q

Which muscles posteriorly border the abdominal cavity?

A

Psoas major

Quadratus lumborum

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21
Q

Which muscles lie anterolaterally to the abdomen?

A

Transversus abdominus
Internal oblique
External oblique

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22
Q

Which muscles lie anteriorly to the abdomen?

A

Rectus abdominus

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23
Q

Blood supply to internal abdominal wall?

A

Epigastric arteries (they anastomose)

  • Inferior epigastric comes off external iliac
  • Superior epigastric is a continuation of internal thoracic artery (referred to as the internal mammary artery in the accompanying diagram)
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24
Q

What is the peritoneum?

A

Single cell layer covering anterior abdominal wall + some viscera

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25
Q

What are retroperitoneal organs?

A

Only anterior aspect of organ covered by peritoneum

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26
Q

What is the mesentery?

A

Double layer of peritoneum which helps to connect an organ to another organ or structure

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27
Q

Where does the greater and lesser sacs lie?

A

Greater sac - cavity anterior to gastro-hepatic ligament

Lesser sac - cavity posterior to stomach

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28
Q

Which parts of the colon are retroperitoneal?

A

Ascending + descending

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29
Q

List all the intraperitoneal organs

A

stomach, spleen, liver, bulb of the duodenum, jejunum, ileum, transverse colon, and sigmoid colon.

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30
Q

List the retroperitoneal organs

A

Duodenum, the cecum and ascending colon, the descending colon, the pancreas, and the kidneys.

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31
Q

The whole GIT is derived from which embryonic cell type?

A

Endoderm

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32
Q

What is the foregut supplied by?

A

Coeliac trunk + pleuxs

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33
Q

What is the midgut supplied by?

A

Superior mesenteric artery + plexus

Drained by superior mesenteric vein

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34
Q

What is the hindgut supplied by?

A

Interior mesenteric artery and plexus

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35
Q

What is the cardia of the stomach?

A

Where the gastro-oesophageal sphincter lies

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36
Q

Largest part of the stomach?

A

Body

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37
Q

From superior to inferior name the parts of the stomach.

A

Fundus - top
Body
Antrum
Pylorus

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38
Q

Functions of the stomach

A

Store + mix food

Regulate release into intestine

Digestion + absorption of protein and vitamin B12

Immune defence - acid

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39
Q

What is the cephalo-gastric reflex indicated by?

What is it’s role?

A

Thought/taste/smell of food

By vagal efferents result = inhibit stomach contraction

It allows stomach to expand without an increase in pressure for food storage during eating

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40
Q

What does the gastro-gastric reflex do?

A

When stomach distends –> inhibition of stomach contraction

It allows stomach to expand without an increase in pressure for food storage during eatin

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41
Q

What is gastro-oesophageal reflex?

A

Passive passage of gastric contents back up into oesophagus

Active would be vomiting

42
Q

What is a physiological sphincter?

A

An area of increased tone E.g. gastro-oesophageal sphincter

Unlike the pyloric sphincter

43
Q

What is GORD?

A

Gastro-oesophageal reflux disease

Can cause Barret’s oesophagus (metaplasia) it is a pre-malignant condition which increases risk of oesophageal adenocarcinoma

44
Q

List the cell types of gastric mucosa

A 
Parietal cells
Chief cells
APUD cells
G cells
Mucus secreting cells
ECL cells
45
Q

What do the parietal cells secrete?

A

Gastric acid + intrinsic factor (IF)

IF needed for B12 absorption

46
Q

What do chief cells of the stomach produce?

A

Pepsinogen which becomes activated into pepsin and begins protein digestion

47
Q

What do G-cells secrete?

A

Gastrin

48
Q

What do ECL cells of stomach secrete?

A

Histamine

49
Q

What do APUD cells in stomach secrete?

A

Somatostatin

50
Q

What do PPIs tagert?

A

Parietal cells have H+/K+-ATPase proton pumps which are targeted.

Prevents H+ being pumped into the lumen

Parietal cells also have K+/Cl- pumps.
H + Cl = HCl

51
Q

Why does vomiting cause metabolic alkalosis?

A

Stomach acid removed via vomiting. Parasym stimulation –> more acid

Stomach makes more HCl but in doing so makes bicarbonate which enters the blood + increases pH

52
Q

How is stomach mucus produced?

A

Parasym stimulation –> ACh –> prostaglandins needed for mucus production

53
Q

How do NSAIDs cause stomach ulcers?

A

They inhibit prostaglandin production which is needed for stomach mucus production.

But gastric acid is still being produced so not enough mucus to product lining of stomach form it’s luminal acid

54
Q

What does somatostatin (from D-cell) do to gastric acid production?

A

Somatostatin reduces acid by acting on ECl-cell so less histamine is released

Histamine increases gastric acid production

55
Q

What is needed in the stomach to activate pepsinogen?

A

HCl

56
Q

What do S-cell in the duodenum secrete?

A

Secretin

In response to intraluminal acid in duodenum

57
Q

What is the role of secretin?

A

Secretin inhibits gastrin production and promotes somatostatin production to reduce HCl in stomach

Secretin protects duodenal cells from excess intraluminal acid

58
Q

H. pylori is a bacterium that causes peptic ulcer disease. How is it able to survive the stomach acid?

A

Has the enzyme urease make alkaline coat via urea breakdown

Flagella to bury into mucus

Inhibits somatostatin production (which would normally inhibit histamine production and inhibits gastric acid production) = net increase in gastric acid

59
Q

What is the plicae circulares of the small bowel microanatomy?

A

Folds in mucosa + submucosa

They are seen as transverse line on lumen of bowels in X-ray (important for differentiation of SI from LI on X-ray)

60
Q

What are villae?

A

Folds of mucosa

They have microvilli

Crypts (named crypts of Leiberkuhn) lie at base of each villus

61
Q

What makes up GALT?

A

Panneth cells - secrete lysozyme

Peyer’s patches - secrete sIgA

62
Q

Is the duodenum retro or intra peritoneal?

A

Retro apart from first part because it’s connected to stomach (intraperitoneal structure)

63
Q

Name the important structures that lie posterior to the 1st part of the duodenum

A

Portal vein
Gastroduodenal artery
Common bile duct

64
Q

Which part of the duodenum lies anterior to right kidney and ureter?

A

2nd part - decending

65
Q

Which part of the duodenum receives bile + pancreatic juice?

A

2nd

66
Q

Which part of duodenum is longest?

A

3rd part (horizontal)

67
Q

Why is the sphincter of Oddi special?

A

Divides embryological foregut from midgut

It is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vater into the second part of the duodenum.

68
Q

Which vessels pass anterior to the horizontal part of the duodenum?

A

Hepatic artery + portal vein

69
Q

Where does the ascending (4th part) of duodenum terminate?

A

Ligament of Trietz

It’s where the jejunum starts

70
Q

Where are Brunner’s glands found?

A

Duodenum only

The secrete alkaline fluid to neutralise gastric acid

71
Q

What does the mesentery contain?

A

Neuromuscular supply

72
Q

How do gastric parietal cells produce acid?

A

Using H+/K+-ATPase

73
Q

What do statins inhibit?

A

HMG-CoA reductase which inhibits the 1st in the rate limit step of cholesterol synthesis

Leads to up-regulation of LDL receptors in the liver

Liver becomes better at removing LDL from circulation

74
Q

Where is B12 absorbed?

A

Terminal ileum

Intrinsic factor-B12 complexes are needed for them to be taken up

IF made in stomach

75
Q

Why can’t dietary iron (Fe3+) be absorbed in it’s current form?

A

Because only Fe2+ absorbed

So Fe3+ reduced to Fe2+ with ferric reductase and HCl

76
Q

Is the pancreas retro or intra -peritoneal?

A

Retro

77
Q

When does acute pancreatitis occur?

A

Activation of peptidases within pancreas (acinar cells) (usually trypsin)

They damage pancreas –> intrapancreatic inflammation –> extrapancreatic inflammation

78
Q

Causes of acute pancreatitis

A

Mainly:

  • Idiopathic 15%
  • Gallstones 40%
  • Ethanol 35%
ERCP (a procedure) 5%
Autoimmune
Scorpion bite
Mumps
Trauma
Steroids
Hyperlipidaemia
Hypothermia
Hypercalcaemia
Drugs

(I GET SMASHED pneumonia)

79
Q

What is chronic pancreatitis usually caused by?

A

LT alcohol use

Exocrine insufficiency –> malabsorption –> steatorrhoea + low faecal elastase

Also present with recurrent abdo/back pain + weight loss

80
Q

How are pancreatic enzymes secreted?

A

As inactive zymogens

81
Q

Role of hepcidin?

A

Reduces total body iron stores

82
Q

What is taeniea coli?

A

3 muscular bands that run longitudinally along bowel bowel

They are shorter than length of bowel so the bowel bunches up so it can fit along taeniea coli

83
Q

What are haustrae?

A

Haustra of the colon are the small pouches caused by sacculation (sac formation), which give the colon its segmented appearance. The teniae coli run the length of the large intestine.

There is a wider distance between haustra than between the circular folds of the small intestine, and the haustra don’t reach around the entire circumference of the intestine, in contrast to circular folds of the small intestine that do.

84
Q

What are appendices epiploicae?

A

Epiploic appendices (appendices epiploicae) are small pouches of the peritoneum filled with fat and situated along the colon (on the outside of the large bowel), but are absent in the rectum.

85
Q

Where is McBurney’s point and why is it special?

A

3/4rds of the way from the umbilicus to the R anterior superior iliac spine

It’s roughly where the appendix usually lies

86
Q

When there is rectal distension (due to mass peristalsis) how does this information get transmitted?

A

S2-4 parasympathetic afferent

Parasymathpetic reflix

S2-4 efferents

Rectal contraction + internal sphincter relaxation

Voluntary control

External sphincter relaxation

87
Q

Which lobe is more superior?

Caudate or Quadrate lobe?

A

Caudate

88
Q

Which ducts come together to form the common bile duct?

A

Cystic duct from gallbladder

Common hepatic duct (from L + R hepatic ducts)

89
Q

The acinus zones is split into 3 zones. Which zone has highest O2 supply and hence most affected by portal vein toxins?

A

Zone 1

90
Q

Which zone in the liver deals with low O2 processes and suffers from hypoxic damage the most?

A

Zone 3

91
Q

Which zone is most likely to be damaged due to build up of pressure in the hepatic vein (e.g. R heart failure)?

A

Zone 3

92
Q

Which zone is most likely to be damaged in paracetamol OD?

A

Zone 1

93
Q

What is the porta hepatis composed of?

A

Hepatic artery
Portal vein
Common hepatic duct

94
Q

What is the dentate line?

A

Differentiation between endoderm and ectoderm

95
Q

The inferior mesenteric vein + splenic vein + superior mesenteric vein joint to form?

A

Portal vein

96
Q

Hepatocytes line what?

A

Sinusoids and form bile canaliculi

97
Q

Functions of the liver

A

Protein synthesis (clotting proteins important!, plasma proteins)

Metabolism (blood glucose)

Bile (digestion + excretion of fats and fat soluble substances)

Immune funciton

Systemic interactions w/ CV + resp systems

98
Q

What are bile acids?

A

Lipid derived, amphipathic weak acids conjugated with and aa (glycine/taurine usually)

99
Q

Amphipathic means?

A

Have both hydrophilic and hydrophobic parts

100
Q

What are bile salts?

A

Bile acids + Na+/K+

101
Q

Where does bile go once synthesised?

A

Gallbladder for storage and concentration

102
Q

What causes gallbladder contraction –> bile delivery to gut?

A

CCK

Cholecystokinin which present made in response to intraluminal fat in the SI

121 (11 decks)

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